Quality indicators for the adult epilepsy monitoring unit

Sauro, Khara M.; Wiebe, Samuel; Macrodimitris, Sophie

doi:10.1111/epi.13563

Cited by 18 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a third agreement trial, we applied the Delphi method to build consensus 28,29 . All answers of the first and second agreement trials were pseudonymously disclosed to the 20 colleagues who completed both previous rounds.…”

Section: Methodsmentioning

confidence: 99%

“…In a third agreement trial, we applied the Delphi method to build consensus. 28,29 All answers of the first and second agreement trials were pseudonymously disclosed to the 20 colleagues who completed both previous rounds. Answers were assembled with (1) histopathological landmark images from selected FFPE blocks and requested immunostainings; and (2) a summary of clinical information including preoperative MRI findings, postsurgical outcome, information about invasive diagnostic evaluation, and potential epilepsy risk factors (Table 1).…”

Section: Third and Fourth Agreement Trials (Delphi Consensus And Gene Panel Analysis)mentioning

confidence: 99%

See 1 more Smart Citation

Toward a better definition of focal cortical dysplasia: An iterative histopathological and genetic agreement trial

et al. 2021

View full text Add to dashboard Cite

Objective Focal cortical dysplasia (FCD) is a major cause of difficult‐to‐treat epilepsy in children and young adults, and the diagnosis is currently based on microscopic review of surgical brain tissue using the International League Against Epilepsy classification scheme of 2011. We developed an iterative histopathological agreement trial with genetic testing to identify areas of diagnostic challenges in this widely used classification scheme. Methods Four web‐based digital pathology trials were completed by 20 neuropathologists from 15 countries using a consecutive series of 196 surgical tissue blocks obtained from 22 epilepsy patients at a single center. Five independent genetic laboratories performed screening or validation sequencing of FCD‐relevant genes in paired brain and blood samples from the same 22 epilepsy patients. Results Histopathology agreement based solely on hematoxylin and eosin stainings was low in Round 1, and gradually increased by adding a panel of immunostainings in Round 2 and the Delphi consensus method in Round 3. Interobserver agreement was good in Round 4 (kappa = .65), when the results of genetic tests were disclosed, namely, MTOR, AKT3, and SLC35A2 brain somatic mutations in five cases and germline mutations in DEPDC5 and NPRL3 in two cases. Significance The diagnoses of FCD 1 and 3 subtypes remained most challenging and were often difficult to differentiate from a normal homotypic or heterotypic cortical architecture. Immunohistochemistry was helpful, however, to confirm the diagnosis of FCD or no lesion. We observed a genotype–phenotype association for brain somatic mutations in SLC35A2 in two cases with mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy. Our results suggest that the current FCD classification should recognize a panel of immunohistochemical stainings for a better histopathological workup and definition of FCD subtypes. We also propose adding the level of genetic findings to obtain a comprehensive, reliable, and integrative genotype–phenotype diagnosis in the near future.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Third and Fourth Agreement Trials (Delphi Consensus And Gene Panel Analysis)mentioning

confidence: 99%

Toward a better definition of focal cortical dysplasia: An iterative histopathological and genetic agreement trial

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Nevertheless, seeking consensus and setting standards of practice are important; recent quality indicators have been developed to standardize measurement and report on quality and safety of care on the EMU [12,13].…”

Section: Survey Findingsmentioning

confidence: 99%

Current practice and recommendations in UK epilepsy monitoring units. Report of a national survey and workshop

Hamandi

Beniczky²,

Diehl

et al. 2017

Seizure

View full text Add to dashboard Cite

show abstract

“…Sauro et al created a non-exhaustive list of AEs that should be recorded in EMU safety studies. 15 Of these AEs, our EMU reports six injuries and four seizure clusters, along with three falls and two postictal aggressive behaviors. Our EMU AE rate of 19.0% is higher than the pooled AE proportion of 7% reported by Sauro et al A factor that contributed to our EMU's higher AE rate was these study's exclusion criteria.…”

Section: Discussionmentioning

confidence: 95%

Intervention Time and Adverse Events in a Canadian Epilepsy Monitoring Unit

Toffa

Assi

et al. 2020

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

Background: Intervention time (IT) in response to seizures and adverse events (AEs) have emerged as key elements in epilepsy monitoring unit (EMU) management. We performed an audit of our EMU, focusing on IT and AEs. Methods: We performed a retrospective study on all clinical seizures of admissions over a 1-year period at our Canadian academic tertiary care center’s EMU. This EMU was divided in two subunits: a daytime three-bed epilepsy department subunit (EDU) supervised by EEG technicians and a three-bed neurology ward subunit (NWU) equipped with video-EEG where patients were transferred to for nights and weekends, under nursing supervision. Among 124 admissions, 58 were analyzed. A total of 1293 seizures were reviewed to determine intervention occurrence, IT, and AE occurrence. Seizures occurring when the staff was present at bedside at seizure onset were analyzed separately. Results: Median IT was 21.0 (11.0–40.8) s. The EDU, bilateral tonic–clonic seizures (BTCS), and the presence of a warning signal were associated with increased odds of an intervention taking place. The NWU, BTCS, and seizure rank (seizures were chronologically ordered by the patient for each subunit) were associated with longer ITs. Bedside staff presence rate was higher in the EDU than in the NWU (p < 0.001). AEs occurred in 19% of admissions, with no difference between subunits. AEs were more frequent in BTCS than in other seizure types (p = 0.001). Conclusion: This study suggests that close monitoring by trained staff members dedicated to EMU patients is key to optimize safety. AE rate was high, warranting corrective measures.

show abstract

Quality indicators for the adult epilepsy monitoring unit

Cited by 18 publications

References 12 publications

Toward a better definition of focal cortical dysplasia: An iterative histopathological and genetic agreement trial

Toward a better definition of focal cortical dysplasia: An iterative histopathological and genetic agreement trial

Current practice and recommendations in UK epilepsy monitoring units. Report of a national survey and workshop

Intervention Time and Adverse Events in a Canadian Epilepsy Monitoring Unit

Contact Info

Product

Resources

About